Home HealthTopics Health Centers Reference Library Research
Join us on Facebook Join us on Facebook Share on Facebook
Share

Sleep Disorders

Cant stop the music from playing in my head

05/20/2004

Question:

especially when i have worries, i will play songs in my head. i lost my father 2 months ago, after he had a long battle with cancer. worry, worry, worry. also, i have trouble sleeping at night. i dream all night long and wake up tired. can you help me! actually, i have always been a worrier, ever since i was 8 years old, i have had much trouble falling asleep. i am now 43 years old, and it really has begun to bother me. is this a form of ocd?

Answer:

Difficulty falling asleep is a common problem known as "sleep onset insomnia." Many individuals will experience this on an occasional basis, usually related to specific life situations such as stress or grief, and are only temporarily affected. Once their life situation is improved, their symptoms will resolve. However, for others, sleep onset insomnia can develop into a chronic condition that has significant impact on their day to day lives and sense of well-being. The causes of persistent or chronic sleep onset insomnia are quite varied. They may range from simple lifestyle issues, such as too much caffeine use or watching too much TV in bed, to more complex problems such as specific sleep disorders or mental health disorders.

Common causes of sleep onset insomnia include poor sleep hygiene (the behaviors surrounding going to bed), excessive stimulant use, medication side effects, a poor sleep environment (for example a noisy bedroom or bed partner that snores loudly), chronic pain, restless legs syndrome (an irresistible need to move the legs when at rest), and learned insomnia (also known as psychophysiologic insomnia). Learned insomnia, in which temporary problems with sleep onset become chronic due to an individual adapting to not going to sleep at their usual bedtime, is actually quite common and requires a thorough history to determine if this is the problem.

Numerous mental disorders have also been associated with sleep problems, especially insomnia. Some of these disorders include mood disorders (such as depression, bipolar disorder, etc.), psychoses, anxiety disorders and panic disorders. You have mentioned that you have recently experienced a significant life event (death of a loved one) . This could certainly bring out or worsen problems with sleep, especially insomnia. In addition, you mentioned that you tend to worry a lot. Worrying can create problems with getting to sleep as well. Worrying keeps the mind active and in a state of alertness, instead of helping to relax the brain and body in preparation for sleep. Excessive worrying may be a sign of an underlying mental disorder, such as anxiety or obsessive compulsiveness. To determine if one of these conditions is present, you should discuss you problems with your doctor. Referral to a mental health specialist or sleep specialist may be indicated, depending upon the specific nature of your symptoms.

In the meantime, some simple measures may help to improve your sleep. One recommendation would be to consider keeping a "worry list" at your bedside. On this list, you can write down, before getting into bed, what you are worried about and thus "free" your mind of these worries. Another recommendation is to develop a relaxing bedtime routine - a warm bath (at least more than 1 hour before bedtime), a light snack (again, at least one hour before bedtime) or some light reading may help to put your mind and body at ease.

In addition to the above recommendations, practicing good sleep hygiene is always useful. Rules of good sleep hygiene are as follows: 1) Maintain a regular wake time, even on days off work and on weekends. 2) Try to go bed only when you are drowsy. 3) Keep a regular schedule. Regular times for meals, medications, chores and other activities help keep the inner clock running smoothly. 4) Avoid napping during the daytime. If you do nap, try to do so at the same time every day and for no more than one hour. Mid-afternoon (no later than 3 PM) is best for most people. 5) Do not spend excessive amounts of time in bed. Use your bed only for sleep, intimacy, and times of illness. 6) A relaxing pre-sleep ritual such as a warm bath, light bedtime snack, or 10 minutes of reading may help. Avoid heavy meals before bedtime. 7) Try to exercise regularly. Vigorous exercise should be limited to earlier in the day, at least six hours before bedtime. Mild exercise should be done no more than 4 hours before bedtime. 8) Avoid ingestion of caffeine within 6 hours per day. "Reasonable" caffeine consumption is considered to be the equivalent of about 1-2 cups of coffee per day. 9) Do not drink alcohol when sleepy. Even a small dose of alcohol can have a significant effect when combined with tiredness and alcohol tends to cause sleep disruption after the first few hours of sleep. Do not drink alcohol while taking sleeping pills or other medications. 10) Avoid the use of nicotine close to bedtime or during the night.

If you would like further information about sleep and sleep disorders, please visit the American Academy of Sleep Medicine`s web site at aasmnet.org/. This website offers plenty of information on sleep and sleep disorders in addition to maintaining a list of Sleep Centers so you can locate one near you. Good luck and here`s to good sleep! 

For more information:

Go to the Sleep Disorders health topic, where you can:

Response by:

Case Western Reserve University Dennis Auckley, MD
Associate Professor of Medicine
Department of Medicine
School of Medicine
Case Western Reserve University
Dennis Auckley, MD